MEDICARE: ODYSSEY HEALTHCARE OPERATING A LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477554368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODYSSEY HEALTHCARE OPERATING A LP

Provider Business Mailing Address
First Line	:	655 BRAWLEY SCHOOL RD STE 200
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-9601
Country	:	US
Telephone Number	:	704-662-0416
Fax Number	:	704-664-1306

Provider Business Practice Location Address
First Line	:	2630 WEST FREEWAY
Second Line	:	SUITE 102
City	:	FORT WORTH
State	:	TX
Zip	:	76102-7117
Country	:	US
Telephone Number	:	817-338-1512
Fax Number	:

Authorized Official
Title or Position	:	SVP OF LEGAL AND COMPLIANCE
Name	:	MS. JESSICA KLEBERG
Credential	:
Telephone Number	:	704-664-2876

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	11/20/2018

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